Obama health plan takes shape

If Congress were to take a vote on a health reform bill today, Democrats and Republicans would find a surprising level of agreement — so much so that the broad outlines of a consensus plan already are taking shape.

Sick or healthy, rich or poor, all Americans would be guaranteed access to health insurance.

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In fact, they’d probably be required to purchase it — perhaps through mandates in the law that would include stiff tax penalties for anyone who tried to opt out.

Newly created insurance marketplaces would make finding a plan as easy as shopping for cheap airfare. People could keep their coverage, even if they switched jobs. And they might be able to choose between private insurers and a government-backed plan.

But here’s the catch — none of this would come free, with the wealthiest Americans likely to face higher taxes to help pay for coverage for all.

It’s hard to believe that only three months ago, health care advocates worried that President Barack Obama would drop the health reform issue from his first-year agenda. Now, with an August deadline to pass a bill, a compromise that once seemed unimaginable is considered quite possible, both sides say.

Congress this week begins a two-month sprint to pass legislation overhauling the health care system — an aspiration that has eluded generations of American politicians. The task is exceedingly complex and faces the legislative equivalent of an Ironman triathlon, tested at every stage by monied interests, political alliances and an estimated 13-figure price tag.

So there’s no guarantee every piece is going to fall into place just like this or even that a final compromise will be forged. But here’s a look at what could be expected in a bill — and what details have yet to be resolved:

Everybody gets in and stays in. The guiding principle of congressional efforts remains universal coverage, or something close to it. This means not just finding a way to cover 50 million uninsured Americans but also making the system more stable and affordable for those who already have insurance through their employer. Now, losing a job means losing coverage.

Why it looks likely: Lawmakers view universal coverage not as much as a moral imperative but as an economic issue. If the aim is to lower insurance premiums for everyone, then the young and the old, the sick and the healthy must be funneled into the system as a way to spread the costs of high-risk patients. The unresolved fight: how to compel participation in the system and how to pay for it. Last month, Senate Finance Committee Chairman Max Baucus (D-Mont.) said “we’re going to try to get as close as we can” to universal coverage, and the Congressional Budget Office estimates the proposals would reach about 95 percent of Americans. But the package of options for achieving even near-universal coverage requires lawmakers to find hundreds of billions of dollars in new tax revenue and spending cuts — money that it hasn’t found yet.

Orbitz for insurance. If there was such a thing as a sure bet in the bill, this would be it: the creation of an insurance marketplace, or “exchange,” where individuals and small employers could compare plans side by side, find options with a minimum benefits package and buy coverage. Insurers would be required to take all comers, regardless of pre-existing conditions. Proponents say it would give individuals a place to find affordable insurance that could go with them from job to job.

Why it looks likely: It is the cornerstone of Democratic and Republican health care proposals. Experts from the conservative Heritage Foundation and the liberal Center for American Progress endorse it. Federal lawmakers already participate in an exchange called the Federal Employees Health Benefits Program — and they have been promising for years to provide the same choices to voters.

“That has to be the one thing that is close enough to a guarantee as you can find,” said David Merritt, a health policy expert at Newt Gingrich’s Center for Health Transformation.